So you say you're a doula...

*WARNING - this is a REALLY long blog post, I promise they won't always be like this.  I just have so much to say on this topic and don't know how to shorten it up!  Forgive me!* 

I've been working on my doula certification for a little over a year and I am ALMOST there!  I was a little bit shocked to have my husband ask me this past week, "what exactly is it you do?  People ask me and I don't know what to tell them."  Huh - so apparently I haven't been doing a very good job of advocating for doulas if my own household doesn't understand a doula's worth! So here's your "Doula 101":

The would doula is a Greek word which means "a woman who serves."  Women have always come together to attend the births of the next generation.  It is only a recent phenomenon that the delivery room is made up of a doctor, a nurse, occasionally a husband/partner and the mother.  Throughout time, it has been the Aunties, the Grandmas, the Sisters and the wise women who passed down the wisdom of the ages to help women bring new life into the world.

Take a look at a fairly average American experience.  The mother checks herself into the hospital usually when she is around 3 cm dilated.  If you're talking solely based on averages/expectations at this point, that woman will be in the hospital for roughly another 7 hours before she begins to actively push that baby out.  And that's 'averages' and 'expectations'.  We all know lots of stories of women who labored for 24+ hours.  Over the course of that time, if she is utilizing the services of an MD and everything is going according to plan, she will see that MD a few brief times before it comes time to push.  She'll likely have an extraordinary nurse to tend to her needs but frequently that nurse will be tending to the needs of other mothers at the same time...and that nurse will go home and be replaced at the end of her shift.  She'll also hopefully have a compassionate, strong partner by her side but that partner, let's face it, will not have experienced what she is going through.  If she's very lucky she will also have a competent doula.  That doula will be by her side from the time she arrives at the hospital until after the baby is born.  She will not trade shifts with someone else, she will have no other mother to tend to and her entire focus will be on that particular mother, that particular father and that particular baby.

Doulas are not medically trained.  We are trained in the use of basic comfort measures and labor positions and we become quickly experienced in "reading" a woman in labor, guiding her support person(s) in the best ways to be there for her and, most importantly in my limited experience, in helping her find and maintain her labor rhythm.  Because we are not medically trained, we are not otherwise occupied with watching & maintaining the monitors, hooking up IV's, checking vitals, etc.  We are focused on the labor itself.  It's a wonderful thing.

To quote DONA (the organization who is certifying me) "Studies have shown that when doulas attend birth, labors are shorter with fewer complications, babies are healthier and they breastfeed more easily." 

This is how a typical experience with me as a doula starts.  If it's a private client, I meet with Mom & Dad sometime around 4 - 6 weeks prior to the due date to discuss the parents' birth plan.  If they have one.  If they don't have one, I encourage them to write one.  I listen to their previous birth stories if there are any.  I find out what their hopes and expectations are for the birth (ie. are they hoping for an nonmedicated birth, are they open to an epidural, etc.).  I find out what their fears are and I try to assuage them either with tidbits of my own knowledge or topics for research.  I also find out what typically calms and soothes the mother in cases of normal, everyday stress (ie. music, hot bath, massage, guided imagery, etc.).  I also give them my "Stacy as your doula speech" which goes a little like this, "I am there for you.  You are absolutely in charge.  It's your day and your time.  I will be by your side until you tell me to leave.  I will not be insulted or hurt by anything that you say or do.  You cannot offend me in that room.  My expectation is that you are brutally honest with me - 'I don't like that' 'Stop talking' 'that helps/doesn't help' all 'Minnesota-nice' needs to go out the window and you need to be 100% honest and forthcoming with your caregivers and with me."

I am then on-call 24 hours a day beginning 2 weeks prior to due date until 2 weeks post due date.  When Mom calls me, I assess with her over the phone where she's at and agree to meet her whenever / wherever she'd like.  Usually I meet up with Mom & Dad as they are checking into the hospital and the real fun starts.

Every woman needs the same basic things in my experience.  They all need to feel supported.  They all need to believe in themselves and in their bodies' ability to do what they are about to do.  They need to trust in their intuition.  They need to let go and trust their attendants to not judge them so that they are free and comfortable enough to relax into their labor.  A relaxed woman (yes - a woman CAN be relaxed while in labor...though my definition and your definition may not be precisely the same) has a much easier time with their labor in general.

Every woman also needs something very different.  Some women (myself, for example) need to be allowed to turn within themselves and focus intently on riding their waves of pain.  Some women need an outside stimulus - pressure on their forehead, pressure on their lower back, someone to sway with them... Some women need a lot of assistance in maintaining slow, even breathing and finding their own labor's rhythm.  Some women need nothing but your presence in the room.  I have spent time doing nothing but sitting quietly in the corner reading my book and making sure that the door always gets closed when someone comes/goes to maintain the quiet or doing nothing but hitting "play" everytime the relaxing CD comes to an end.

As a doula, I do not judge a woman's decisions.  I am not inside of her labor and while I know precisely what MY labors were like...I do NOT know what HER labor is like.  I work hard to trust her judgement and to support her decisions.  I do not advocate for a mother with the medical staff.  I do not communicate to the medical staff for the mother.  What I DO occasionally do is make certain that a mother knows that she has the right to ask questions and that she (except in cases of emergency) has the right to take a quiet moment alone to think through a major medical decision.

I know - I know - that all sounds very ethereal, lovey-dovey, gooshy...if you want to get down the nitty-gritty of it, this is what I really find myself doing as a doula:

I hold Mom's hand, I direct Dad's massage, I say "this is normal" at least a million times, I ice down wash cloths and put them on Mom's forehead, shoulders and wash her face.  I hold a basin or bag while Mom throws up and then assure her that, again, it's normal AND it happens to me all the time AND it's ok.  I help her to the toilet, I help her in and out of the tub.  I say, "in through your nose and out through your mouth" a hundred times.  I encourage Mom to make noise if it helps her - always low noises, never high.  I encourage her to rest between contractions as long as she can and then I encourage her to try different positions, move, shift.  I covertly direct the rhythm of her breathing, swaying, head-nodding, etc. by use of my own humming, breathing, hand stroking.  I close the door.  I ask her about her baby - baby's name, baby's nursery, hopes & dreams for baby down the road - to remind her that her pain has a purpose without saying those horrible words because WHO wants to have their pain minimized by being told "your pain has a purpose"?

I'm working on completing the certification process to be a DONA certified doula.  (Check out www.dona.org to find out more about the organization and detailed information about certification.)  Certification, in a nutshell, requires that I attend a 2 day long seminar that had my head spinning full of information.  Also requires that I attend a day long seminar on breastfeeding and a full-length childbirth class (Lamaze or Bradley).  Then I  must attend 3 births and, with mother's permission, document them thoroughly with evaluations.  There is a bunch of reading and some minor researching and paperwork to accomplish.  I have finally attended my 3rd birth (though I have actually attended 7 at this point - but, for various reasons, they won't all "count") and all I have left is my childbirth class and some paperwork.  And then.  I will finally be a certified doula.  I'm not sure this means much for me in terms of how it will change my work. I will probably continue to volunteer at Woodwinds, maintain my certification and take a private client or two a year.  I am hoping that once the girls are a little bit older, I might be able to turn this into a supplemental career and some extra income but the on-call lifestyle is really difficult with 2 little girls to care for and a husband who travels.

In the meantime, I feel very fulfilled when I feel like I've contributed to building beautiful birth stories for new Moms (or new again Moms).  I feel even more amazed when I can help a Mom enjoy (ok - that's a strong word) feeling all of her labor and delivery.  The look on a woman's face immediately after that last push is amazing!  While I won't be sharing specifics of any mom's birth stories online (that would just be totally rude), I do hope to blog more about my doula work in the future...I swear future posts will be more concise!  :)